Nekaj podatkov iz Poročila o rezultatih državnega programa ZORA v letih 2006 in 2007

The national cervical cancer screening program (with the name ZORA after Slovenian initials for organized cervical cancer screening program) has the goal to decrease cervical cancer incidence and mortality in Slovenia. As in the nineties, despite regular smear taking activity in gynecological practice (opportunistic screening), the cervical cancer incidence started to increase. In 2003, after the initial pilot study, an organized screening program was established. Each woman aged between 20 and 64 years should be invited to a preventive gynecological examination, including PAP smear once in every three years (after two negative smears) - either by her “personal” gynecologist with whom she has already been registered or by the Screening Center in case she has not been registered yet. All smear reports (in electronic form) from all cytological laboratories are gathered in the central database of the Screening Registry that is linked to the central Population Registry. The Screening Registry enables also sending invitations to the women whose smear has not been registered for four years. National guidelines for quality assurance and control of all procedures involved in cervical cancer screening and treatment of intraepithelial lesions and of cervical cancer were prepared. In the Screening Registry at the Institute of Oncology Ljubljana, all smear and pathology reports are registered. These data serve to monitor coverage and compliance with screening together with other screening performance indicators. The condition for establishing such an information system was a uniform smear report and standardization of work in cytopathology laboratories. Four years after the start of the program, 70% of women in the target age group (20–64 years) had at least one smear registered in the Screening Registry. The percentage is about 80% till the age of 45 and smaller among older women. In 2006, 245.416 smears were registered from 220.820 women; 176.633 women attended the screening (80%), in others, smears were taken as follow-up or because of clinical indications. Screening smears were less adequate or inadequate in 5.9% of cases, and in 7.2%, any cell abnormality was found. In Cervical Pathology Registry, 8.620 histological reports were registered, more than half of them were from diagnostic biopsies. In 2006, 160 new cervical cancer patients were registered. The linkage of their data with the Screening registry enables us to review their screening history; nearly three quarters of these patients did not attend regular screening. According to the data from the Cancer Registry of Slovenia, the incidence rate of cervical cancer started to decrease, especially in the age group of 35 to 49 years.Cilj državnega programa ZORA (po začetnicah naslova programa – Zgodnje Odkrivanje predRAkavih sprememb materničnega vratu, DP ZORA) je zmanjšati obolevnost in umrljivost za rakom materničnega vratu (RMV) v Sloveniji. Ker se je incidenca RMV ob koncu devetdesetih let kljub že desetletja uveljavljenim preventivnim pregledom povečala, je bil po začetni pilotni fazi na državni ravni leta 2003 vzpostavljen organiziran presejalni program. Povečal naj bi delež žensk v ciljni starostni skupini od 20 do ¬64 let, ki se udeležujejo rednih presejalnih pregledov brisa materničnega vratu (BMV), na najmanj 70 %, tudi s pisnimi vabili tistim, ki se teh pregledov same ne udeležujejo. Za vabila opredeljenim ženskam, ki v določenem intervalu same ne pridejo na pregled, so bili zadolženi ginekologi, za vabila neopredeljenim pa Register ZORA, ki podatke o prebivalkah dobiva iz Centralnega registra prebivalstva. Register ZORA deluje tudi kot varnostni mehanizem z vabili vsem, ki v štirih letih nimajo registriranega izvida. Vsak organizirani program mora stremeti k vrhunski kakovosti vseh postopkov, zato so bile izdelane smernice za zagotavljanje kakovosti vseh postopkov v DP ZORA. Centralni informacijski sistem (Registra ZORA) na Onkološkem inštitutu v Ljubljani, v katerem se zbirajo vsi izvidi brisov materničnega vratu in izvidi patohistoloških preiskav, omogoča spremljanje stopnje pregledanosti in kakovosti, presejalnega in morebitnih diagnostičnih postopkov. Predpogoj za ta sistem pa je bila prvič doslej standardizirana dejavnost laboratorijev za ginekološko citopatologijo, kar omogoča spremljanje dela laboratorijev. V dobrih treh letih po začetku organiziranega presejanja za odkrivanje RMV se je v ciljni skupini žensk, zajetih v program ZORA, povečala stopnja pregledanosti na ciljno vrednost 70 %. V letu 2006 je bilo pri 220.820 ženskah odvzetih in pregledanih 245.416 BMV. Na presejalnem pregledu je bilo 176.633 žensk (80 %), druge so prišle na kontrolni pregled ali pa so imele klinične težave. V registru histoloških izvidov smo registrirali 8.620 izvidov, nekaj več kot polovico jih je rezultat diagnostičnih posegov (ekscizije, biopsije in abrazije). Od bolnic, zbolelih za RMV v letu 2006, je skoraj tri četrtine takih, ki niso hodile na redne presejalne preglede. Podatki Registra raka za Slovenijo kažejo, da se incidenca raka materničnega vratu od leta 2003 zmanjšuje, predvsem v najbolj ogroženi skupini žensk med 35. in 49. letom starosti, pri katerih je tudi največ patoloških izvidov BMV